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Evidence-based Project: Alarm Fatigue

EF

Eleanor Fine

Transcript

EB Project: Alarm Fatigue

Presented by Chris Plampin, Ellie Fine, Montana Nash, and Whitney Kelley

Findings

Nursing Empowerment

  • Nursing staff has the ability to alter default settings when an alarm is not indicative of a clinical event requiring intervention
  • No physician order required to change parameters

Alarm Fatigue:

Why do we care?

Our PICOT Question:

Findings

Why is this important to 8B?

Training and Education

Alarm Parameters

Would staff nurses on a telemetry unit experience less clinical alarm fatigue if they were empowered to adjust alarm parameters on an individual patient basis compared to current default alarm settings.

What are the current parameters on 8b?

  • Excessive alarms in patient care are distracting and interfere with the ability of nurses to perform critical patient care tasks
  • After excessive exposure, nurses are less responsive because they believe the alarms to be less meaningful
  • Not responding to alarms has caused serious patient injury and death in the past
  • Nurses experience many interruptions throughout the day throughout their day. They are paged:
  • when a patient orders their meal
  • when a patient presses their call button
  • when a transporter, physical therapist, or other healthcare team member presses the call button to get the nurse’s attention
  • when a telemetry monitor alarms
  • when a physician or other provider sends or returns a page

  • Our findings support increased training on telemetry monitoring software as a means to reduce clinical alarm fatigue.
  • Staff are unaware of the various capabilities of their monitoring systems.
  • The articles were not specific as to the type of training necessary, however “on the job” training by an RN preceptor was deemed insufficient.
  • We suggest a periodic in-service training session hosted by the monitoring developer as was done with MiChart.
  • This training would allow nurses to feel more comfortable with changing parameters and ensuring the monitors capture and notify staff with the appropriate alarms and notifications.

All parameters are set the same.

Parameters need a physician

order to be changed

Findings

Resources

Outlining Plans for Tiers of Coverage

Findings

Changing alarm default settings

Bonzheim, K., Gebara, R., O'hare, B., Ellis, R., Brand, M., Balar, S., ... Haines, D. (2010). Communication Strategies and Timeliness of Response to Life Critical Telemetry Alarms.Telemedicine and E-Health, 241-246.

Cvach, M. (2012). Monitor alarm fatigue: an integrative review. Biomedical Instrumentation & Technology, 46(4), 268-277.

Graham, K., & Cvach, M. (2010). MONITOR ALARM FATIGUE: STANDARDIZING USE OF PHYSIOLOGICAL MONITORS AND DECREASING NUISANCE ALARMS. Critical Care Management, 36-37. Retrieved September 27, 2014, from http://dl2af5jf3e.search.serialssolutions.com.proxy.lib.umich.edu/?sid=Entrez:PubMed&id=pmid:20045845

Gross, B., Dahl, D., & Nielsen, L. (2011). Physiologic monitoring alarm load on medical/surgical floors of a community hospital. Biomedical Instrumentation & Technology, 4529-36. doi:10.2345/0899-8205-45.s1.29

Harris, R. M., Manavizadeh, J., McPherson, D. J., & Smith, L. (2011). Do You Hear Bells? The Increasing Problem of Alarm Fatigue. Pennsylvania Nurse, 66(1), 10-13.

Keller, J., Diefes, R., Graham, K., Meyers, M., & Kathy, P. (2011). Why Clinical Alarms Are a ‘Top Ten’ Hazard: How You Can Help Reduce the Risk. Horizon, 18-23.

McKinney, M. (2014). Hospital's simple interventions help reduce alarm fatigue. Modern Healthcare, 44(5), 26-7. Retrieved from http://search.proquest.com.proxy.lib.umich.edu/docview/1494794766?accountid=14667

Whalen, D., Covelle, P., & Piepenbrink, J. (2014). Novel Approach to Cardiac Alarm Management on Telemetry Units. Journal Of Cardiovascular Nursing, 29(5), E13-E22. Retrieved September 27, 2014, from http://dl2af5jf3e.search.serialssolutions.com.proxy.lib.umich.edu/?sid=Entrez:PubMed&id=pmid:24365870

  • HR limits to 45-130 (new default)
  • Increasing premature ventricular contraction (PVC) limit from 6 to 10 per min

Alarm type:

  • Advisory: A-fib (etc.) - notifies nurse but doesn’t require immediate action
  • Crisis: Require the alarms to be immediately viewed by nursing staff

  • Findings reported that the average response time for nurses responding to a telemetry alarm was 9.5 minutes.
  • This average places patients in danger of having their cardiac emergencies ignored.
  • Articles supported tiers of coverage similar to the buddies system already in place at 8B.
  • Nurses must respond to page within three minutes; if not, the nurse is paged again and, in case of 8B, the buddy is also paged